Male Infertility
Description
Infertility is defined as the inability to conceive, or become pregnant, after one year of unprotected intercourse. Approximately 15% of couples in the United States are affected by infertility. A third of the time the cause is linked to the woman and another third of causes are linked to the man. The remaining third of cases are variable. Some can be linked to both the man and the woman while in other situations, no cause is ever found.
Symptoms
The primary symptom of infertility is the inability to achieve pregnancy. Other symptoms may include abnormal hair growth or sexual dysfunction.
Diagnosis
Evaluation should be performed if the couple is attempting to conceive for over one year with regular unprotected intercourse. This evaluation may be performed sooner if the couple has male or female infertility risk factors or questions the male’s fertility potential. A detailed history and physical examination will be obtained from the male. Some questions that may be asked involve the timing and frequency of intercourse, use of lubricants (some may be spermicidal), ability to get erections, medical history and past history of pregnancy with other partners. A history of undescended testicles, surgery or trauma in the scrotal or groin area, treatment with radiation or chemotherapy, use of anabolic steroids or a family history of cystic fibrosis are all potential risk factors. A review of the female’s medical, reproductive and surgical history will also be reviewed. A semen analysis will likely be requested. It is important to abstain from intercourse at least 3 days prior to collection of the specimen. The sperm specimen must be kept at room or body temperature and be examined within one hour of collection. If the semen analysis is abnormal, a second semen analysis may be obtained. These specimens should be collected at least one month apart. A blood test may also be ordered to evaluate for abnormal hormone production. Additional testing may also be needed.
Treatment
Potential treatments of infertility will be determined based on the cause. If sperm production is low, a medicine may be tried to increase the number of sperm. Surgery may also be needed to improve the sperm production. The most common types of surgical repair are a varicocele repair and a vasovasotomy. Varicoceles are the most common surgically correctable cause of infertility. Varicocele repair can improve semen parameters by more than 50% and increase pregnancy rates by 35-40%. In cases of blockage of the vas deferens or a previous vasectomy, the vas deferens can be reconnected using outpatient microscopic surgical repair. Assisted reproductive technology, ART, may be needed in cases where medical or surgical therapy is not indicated or has failed. The female is usually given a medicine to stimulate multiple eggs to mature. These mature eggs are then harvested. Intracytoplasmic sperm injection (ICSI) may also be used by injecting a single sperm directly into a mature egg. Infertility issues can be extremely stressful and cause significant emotional and financial problems for the individual and couple. It is common for couples to have feelings of depression, inadequacy and severe stress. These individuals commonly benefit from support groups or counselors. Setting limits both emotionally and financially are recommended. It is also important to determine what your personal and financial limits are in trying to conceive a child.
Hematuria
Description
Hematuria can occur in up to 10% of the population. Hematuria is the presence of blood, specifically red blood cells, in the urine. Whether the blood is visible only under a microscope or visible to the naked eye, hematuria may be a sign that something is bleeding in the genitourinary tract: the kidneys, the tubes that carry urine from the kidneys to the bladder (ureters), the prostate gland (in men), the bladder, or the tube that carries urine from the bladder out of the body (urethra). Bleeding may happen once or it may be recurrent. It can indicate different problems in men and women. Causes of this condition range from non–life threatening (e.g., urinary tract infection, kidney stones) to serious (e.g., cancer, kidney disease). It is important to notify your doctor if you are concerned that you may have hematuria. There are two types of hematuria, microscopic and gross (or macroscopic). In microscopic hematuria, the amount of blood in the urine is so small that it can be seen only under a microscope. A small number of people experience microscopic hematuria that has no discernible cause (idiopathic hematuria). These people normally excrete a higher number of red blood cells. With gross hematuria the urine may be pink, red, or dark brown and can contain small blood clots. The amount of blood in the urine does not necessarily indicate the seriousness of the underlying problem. As little as 1 milliliter (0.03 ounces) of blood can turn the urine red. "Joggers hematuria" results from repeated jarring of the bladder during jogging or long-distance running. Reddish urine that is not caused by blood in the urine is called pseudohematuria. Excessive consumption of beets, berries, or rhubarb; food coloring; and certain laxatives and pain medications can produce pink or reddish urine. Many conditions are associated with hematuria. The most common causes include the following: Benign prostatic hyperplasia, kidney stones, kidney disease, trauma, tumors, urinary tract blockage, infections of the urinary tract, sickle cell anemia and systemic lupus erythematosus.
Signs and Symptoms
In many cases, blood in the urine (gross or microscopic) is the only sign of a disorder. In others, a variety of symptoms, such as urinary frequency, hesitance, incomplete voiding, painful urination or abdominal pain may be present.
Diagnosis
Your doctor will obtain a detailed history and physical examination. Your urine will be examined under the microscope for the presence of red blood cells and other abnormalities. Your doctor may order a radiology imaging study called a CT scan, intravenous pyelogram (IVP) or a magnetic resonance imaging (MRI). Your doctor may also send the urine for cytology looking for cancer cells. Finally you may be scheduled for cystoscopy. This is a test where your doctor can pass a small flexible tube through your urethra to evaluate your bladder, prostate and ureteral openings.
Treatment
Treatment for microhematuria will depend on what your doctor finds after a thorough evaluation. Treatment ranges from observation to antibiotic therapy to surgery.
Minimally Invasive Urologic Surgery
Prostate Cancer
Laparoscopic Nerve-Sparing Robotic Assisted Radical Prostatectomy - a minimally invasive urologic technique using robotic assisted surgery to remove the prostate in patients affected with prostate cancer
Enlarged Prostate
Transurethral Laser Vaporization of the Prostate - a minimally invasive urologic technique that uses a small flexible tube introduced through the urethra and high energy lasers to remove the obstructing portions of the prostate Transurethral Resection of the Prostate - a minimally invasive urologic technique that uses a small flexible tube introduced through the urethra to scoop out the obstructing portions of the prostate Microwave Therapy for the Prostate - a minimally invasive urologic technique done in the clinic that uses microwaves emitted from a catheter placed in the urethra to shrink the prostate gland
Kidney Cancer
Laparoscopic Radical Nephrectomy – a minimally invasive urologic technique that removes the entire kidney) Laparoscopic Partial Nephrectomy – a minimally invasive urologic technique that removes small kidney tumors, leaving behind the unaffected portion of the kidney Laparoscopic Cryoablation of Kidney Tumors – a minimally invasive urologic technique that uses a small needle passed through the skin to freeze small kidney tumors
Kidney Stones
Extracorporeal Shock Wave Lithotripsy (ESWL) – a non-invasive urologic technique that uses external shock waves to break up kidney and ureteral stones Ureteroscopic Removal of Kidney and Ureteral stones – a minimally invasive urologic technique that uses a small flexible tube advanced through the urethra and bladder to the ureter/kidney to remove kidney stones. Percutaneous Nephrolithotomy (PCNL) – a minimally invasive urologic technique that uses a very small incision in the back to remove large kidney stones
Kidney Obstruction
Laparoscopic Pyeloplasty – a minimally invasive urologic technique that reconstructs the junction of the ureter and kidney, ureteropelvic junction or UPJ, removing the blockage
Kidney Cysts
Laparoscopic Ablation/Decortication of Kidney Cysts – a minimally invasive urologic technique that removes or drains large kidney cysts
Bladder Cancer
Transurethral resection of Bladder Tumor – a minimally invasive urologic technique that uses a small flexible tube introduced through the urethra to remove bladder tumors. The remaining tissue near the tumor is coagulated to kill nearby tumor cells. Laparoscopic Robotic Assisted Radical Cystectomy – a minimally invasive urologic technique that uses robotic assisted surgery to remove the entire bladder and nearby affected organs in patients affected with invasive bladder cancer
Testicular Cancer
Laparoscopic Retroperitoneal Lymph Node Dissection – a minimally invasive urologic technique that removes lymph nodes in the abdomen affected with testicular cancer cells
Pelvic Prolapse
Laparoscopic Robotic Assisted Sacrocolpopexy – a minimally invasive urologic technique to correct vaginal vault prolapse
Adrenal Tumors
Laparoscopic Adrenalectomy – a minimally invasive urologic technique to remove the affected adrenal gland
